Healthcare Provider Details

I. General information

NPI: 1265586564
Provider Name (Legal Business Name): JOEL NOVACK DPM, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 03/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20050 HARVARD RD SUITE 205
WARRENSVILLE HEIGHTS OH
44122-6816
US

IV. Provider business mailing address

PO BOX 391660
SOLON OH
44139-8660
US

V. Phone/Fax

Practice location:
  • Phone: 216-491-9151
  • Fax: 216-491-7243
Mailing address:
  • Phone: 216-491-9151
  • Fax: 440-491-7243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number36001391
License Number StateOH

VIII. Authorized Official

Name: DR. JOEL NOVACK
Title or Position: PRESIDENT
Credential: DPM
Phone: 216-491-9151